NICE weight gain prevention guideline

Preventing excess weight gain

Encourage people to make changes in line with existing advice

Encourage everyone to:

Establish and maintain a combination of increased physical activity and healthier dietary habits to achieve and maintain energy balance

Follow existing advice on the recommended level of physical activity because it is likely to help increase energy expenditure and reduce the risk of diseases associated with excess weight. (For existing advice on physical activity see NHS Choices)

Follow existing advice on healthy eating because it will make it easier to have an appropriate energy intake. (For existing advice on healthy eating see NHS Choices)

Avoid extreme physical activity or dietary behaviours (such as obsessively exercising or aiming to avoid all carbohydrates) because they are difficult to sustain and may not be accompanied by wider improvements in health

Identify perceptions, habits or situations that may undermine efforts to maintain a healthy weight or prevent excess weight gain in the long term, and offer practical examples of helpful alternatives. These may include:

maintaining healthier physical activity and dietary habits most days (including at weekends) and during holidays (for example, the school summer holiday)

avoiding giving 'sweet treats' as a reward or giving them regularly as gifts

checking food and drink labels as a guide to appropriate portion sizes

being aware that even food and drinks perceived as 'healthy' (such as olive oil, fruit juice, nuts) can contribute to weight gain if large amounts are consumed

Encourage physical activity habits to avoid low energy expenditure

Encourage people to be more physically active and to reduce sedentary behaviour. Encourage people to build activity into daily life, developing routines and habits that gradually increase the amount and intensity of activity they do. This may include:

Increasing regular walking, particularly brisk walking, or cycling as a form of active travel (to school, work or other local destinations). (See NICE's guideline on walking and cycling)

Increasing activities during leisure time and breaks at work or school (including some periods of moderate-to-vigorous physical activity). This could include any form of physical activity, sport or exercise such as walking, cycling, swimming, dancing or gardening

Increasing activity as part of daily routines (such as taking regular breaks from sitting at home or work, and taking the stairs instead of the lift)

Reducing TV viewing and other screen time. Advise people that any strategy that reduces TV viewing and other leisure screen time may be helpful (such as TV-free days or setting a limit to watch TV for no more than 2 hours a day)

Encourage dietary habits that reduce the risk of excess energy intake

Encourage everyone to follow a dietary pattern that is mainly based on vegetables, fruits, beans and pulses, wholegrains and fish. In addition, everyone should be encouraged to:

Reduce the overall energy density of the diet. Practical ways to achieve this may include:

reducing how often energy dense foods and drinks (such as fried foods, biscuits, savoury snacks, confectionery and drinks made with full fat milk or cream) are eaten

substituting energy dense items with foods and drinks with a lower energy density (such as fruit and vegetables or water)

Avoid sugary drinks (including carbonated drinks, sports drinks, squashes and any other drinks that contain free sugars). Everyone should be encouraged to choose water or other drinks that do not contain free sugars. Other suitable drinks may include coffee, tea or drinks containing non-nutritive sweeteners, such as 'diet' versions of carbonated drinks or squashes

Reduce total fat intake. Practical ways of doing this may include choosing lower fat options of the main sources of fat in the diet, reducing portion size or frequency of consumption of foods high in fat (such as meat and meat products, milk and dairy products, fats and oils, and baked foods such as pizza, biscuits and cakes)

Eat breakfast but do not increase overall daily energy intake. Breakfast choices should reflect existing healthy eating advice. Practical ways to achieve this may include opting for unsweetened wholegrain cereals or bread, lower fat milk and a portion of fruit

Increase the proportion of high fibre or wholegrain foods eaten. Practical ways to do this may include:

opting for higher-fibre foods (such as oats, fruit and vegetables, beans, peas and lentils) in place of food and drinks high in fat or sugar

Limit intake of meat and meat products. Follow existing advice from NHS Choices to eat no more than 70 g of red and processed meat a day on average. Practical ways to do this may include reducing the portion size of meat or how often meals including meat are eaten

Further advice for parents and carers of children and young people

In addition to the advice above, encourage parents, carers and everyone in regular contact with children and young people to:

Help children and encourage young people to get enough sleep. Explain to parents and carers that this is because lack of sleep may increase the risk of excess weight gain in children and young people. Provide parents and carers with information on age-specific recommendations on sleep (for more information, see NHS Choices)

Encourage adults to limit the amount of alcohol they drink

Adults should not exceed recommended levels of alcohol consumption

Advise adults that all alcoholic drinks are a source of additional energy. For example, a man drinking the upper daily limit of 3–4 units will be consuming around 200–325 extra calories a day and a woman drinking the upper daily limit of 2–3 units will be consuming around 140–260 extra calories a day. Practical ways to limit alcohol consumption may include replacing alcoholic drinks with non-alcoholic drinks that do not contain free sugars and increasing the number of alcohol-free days. For more information see advice on drinking alcohol on the NHS Choices website

Encourage self-monitoring

Encourage habits that may help people to monitor their weight or associated behaviours. Practical examples for adults to do this may include:

checking their physical activity level (for example, by noting down activities, or using a pedometer or an app to track physical activity). (See recommendation 7 in NICE's guideline on walking and cycling)

checking their food and drink intake (for example, by noting down meals and snacks, using an app to track intake, or checking food and drink labels). For apps that may be helpful, see NHS Choices

Clearly communicate the benefits of maintaining a healthy weight

Clearly communicate the broad range of benefits of maintaining a healthy weight through being more physically active and improving dietary habits. These should include 'non health' benefits as well as improvements to health. For example:

Ensure activities are integrated with the local strategic approach to obesity

Ensure that any activities promoting behaviours that may help people maintain a healthy weight or prevent excess weight gain are integrated with the local strategic approach to obesity (see recommendation 1 in NICE's guideline on obesity: working with local communities). Activities should:

target and tailor activities, using local knowledge (such as the Joint Strategic Needs Assessment or local surveys), to meet the needs of the population, recognising that some groups may need more support than others (for example, see recommendation 3 in NICE's guideline on walking and cycling and recommendation 2 in NICE's guideline on preventing type 2 diabetes)

full guideline available from… National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BTwww.nice.org.uk/NG7

National Institute for Health and Care Excellence. Preventing excess weight gain. First included: April 2015.